Delirium and acute stroke: the occurrence of delirium and its association with long term outcomes for patients post-stroke

Introduction: Delirium is an acute generalised impairment of brain function and a common complication of illness in older people. However it is commonly overlooked or misdiagnosed in clinical practice. Previous studies have found that delirium is linked to longer hospital stays, an increased need for institutionalisation and future complications e.g. increased risk of dementia and mortality. Delirium onset may be associated with an acute stroke, although few studies have investigated this association. The aims of this study were to identify delirium incidence in stroke, compare long term patient outcomes and identify confounding variables that may affect delirium onset.
Methods: Based on the findings from the systematic review, a UK based prospective cohort study with a one year follow up period was designed to recruit stroke patients with and without delirium. Additional assessments were administered within 72 hours of admission to assess physical function, mood, risk of dementia and cognitive impairment. These assessments were repeated six months post-stroke as well as monitoring outcomes such as mortality, length of stay and discharge destination.
Results: A total of 298 patients were recruited from the stroke unit at the Leeds Teaching Hospitals Trust, with a delirium incidence of 32.9%. Patients with delirium were associated with longer hospital stays, higher mortality rates at one and six months and an increased need for institutionalisation, as well as positive associations with a number of predisposing factors. Delirium patients also had lower assessment scores for physical function and dementia risk at six months.
Conclusion: The results of this study show that delirium has a significant effect on outcomes for stroke patients. Increased emphasis and awareness of delirium on the stroke units could help increase detection rates of delirium. Suggestions for the implementation of better education programmes and screening protocols may aid delirium management and these require further research.